Health Affairs https://www.healthaffairs.org and the National Pharmaceutical Council https://www.npcnow.org hosted the forum “Health Spending: Moving from Theory to Action” at the National Press Club in Washington D.C. The discussion centered on the pressures presented by soaring health costs on individuals, employers, and government. Also discussed were the strategies used by payers and others to promote cost effective care and the efforts underway to bring costs under control.
Alan Weil, Editor-in-Chief, Health Affairs and Robert Dubois, Chief Science Officer and Executive VP, National Pharmaceutical Council welcomed the discussion on how to promote and develop cost effective care to bring costs under control.
Reed Tuckson, Managing Director of Tuckson Health Connections LLC, said, “Since the U.S does not present a single unified coordinated health system, high healthcare costs are affecting many Americans today.
- Medical cost trends although flat for two years is expected to increase in 2020
- Healthcare for a family covered by a large employer cost an average of $22,885 last year
- One-third of adults struggle with medical bills
- 58% of Americans have less than $1,000 saved
- 60% of millennials don’t have enough money to pay for an emergency if it should arise
- Adults with medical bills have used up their savings
- Hospitals are the biggest drivers for inpatient spending
- Physician compensation is increasing
With Robert Dubois as Moderator, Otis Brawley, Professor at Johns Hopkins University https://www.jhu.edu, and a leader on cancer research and effective cancer screening, promotes early cancer detection along with providing quality treatments. The goal is to not only detect and treat cancer but also deal effectively with the necessary health spending related to cancer care.
The main concern for Dan Ollendorf, Director, Value Measurement and Global Health Initiatives, Center for the Evaluation of Value and Risk in Health (CVER) at Tufts University Medical Center, https://cevr.tuftsmedicalcenter.org is that value must always be considered as part of the conversation as to whether new therapies and innovations are worth the money.
He said, “It is important to assess health gains and costs along with areas of uncertainty. For example, medical technologies might be used in a number of centers in a community to fight a disease such as cancer, but there may not be the need to use medical technology in as many centers in other communities. Realizing that communities may differ in their health needs can make it possible for communities to achieve health savings.
Surya Singh, President, Singh Healthcare Advisors, https://linkedin.com/in/surya-singh-8540032 stressed the need to evaluate services and focus on the financial aspects. As he explained, “Every service isn’t for everyone. For example, spine surgery has to be precise and individualized for patients.”
Elizabeth Mitchell, President and CEO, Pacific Business Group on Health (PBGH) https://www.pbgh.org described PBGH, as a member organization, that includes private employers and public agencies to operate as a powerful voice for consumers and patients. She said, “PBGH’s goal is to advance primary care and obtain savings in primary care by investing in high value care.”
PBGH established the “Employers Centers of Excellence Network” (CoE) to provide employees access to demonstrated high quality care for elective surgeries at selected CoEs across the U.S. Through the ECEN, patients receive care at little or no cost and employers achieve cost savings.
The ECEN offers knee and hip replacement surgeries, spine and bariatric procedures, and certain oncology services at hospital systems in the U.S. It was found that over 50% of the patients referred for spine surgery didn’t need the operation.
Success has been achieved by encouraging employees to use carefully selected high quality hospitals and surgeons for the procedures. The ECEN is a success since the Network reduces variations in quality and cost and thereby increases optimal patient outcomes.
An effective program providing high value care is taking place in North Carolina is now successfully addressing the move to value-based care by using a system wide approach. Patrick Conway MD, President and CEO, Blue Cross and Blue Shield of North Carolina, (Blue Cross NC) https://www.bluecrossnc.ocm reports, “Blue Cross NC and NCDHHS are working together to lead transformation in the state. The goal is to enable private insurers to make healthcare better, simpler to use, and make it affordable for all.”
He seeks to see North Carolina’s “Call to Action” make it possible for insurers to provide payments based on value, enable individual consumers to shop for healthcare based on value, and lastly, make it possible for employers to demand value.